Provider Demographics
NPI:1962671636
Name:POLICASTRO, RONALD J (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:J
Last Name:POLICASTRO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:18111 BROOKHURST ST
Mailing Address - Street 2:STE 5200
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6728
Mailing Address - Country:US
Mailing Address - Phone:714-962-7705
Mailing Address - Fax:714-962-7701
Practice Address - Street 1:18111 BROOKHURST ST
Practice Address - Street 2:STE 5200
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6728
Practice Address - Country:US
Practice Address - Phone:714-962-7705
Practice Address - Fax:714-962-7701
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2010-07-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG40687207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G406870Medicaid
CAA48315Medicare UPIN
CA00G406870Medicaid